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Abstract

Screening methods for neonatal hyperbilirubinemia:benefits, limitations, requirements, and novel developments

Severe neonatal hyperbilirubinemia (SNH) is a serious condition that occurs worldwide. Timely recognition with bilirubin determination is key in the management of SNH. Visual assessment of jaundice is unreliable. Fortunately, transcutaneous bilirubin measurement for screening newborn infants is routinely available in many hospitals and outpatient settings. Despite a few limitations, the use of transcutaneous devices facilitates early recognition and appropriate management of neonatal jaundice. Unfortunately, however, advanced and often costly screening modalities are not accessible to everyone, while there is an urgent need for inexpensive yet accurate instruments to assess total serum bilirubin (TSB). In the near future, novel icterometers, and in particular optical bilirubin estimates obtained with a smartphone camera and processed with a smartphone application (app), seem promising methods for screening for SNH. If proven reliable, these methods may empower outpatient health workers as well as parents at home to detect jaundice using a simple portable device. Successful implementation of ubiquitous bilirubin screening may contribute substantially to the reduction of the worldwide burden of SNH. The benefits of non-invasive bilirubin screening notwithstanding, any bilirubin determination obtained through non-invasive screening must be confirmed by a diagnostic method before treatment. ImpactKey message: Screening methods for neonatal hyperbilirubinemia facilitate early recognition and timely treatment of severe neonatal hyperbilirubinemia (SNH). Any bilirubin screening result obtained must be confirmed by a diagnostic method. What does this article add to the existing literature? Data on optical bilirubin estimation are summarized. Niche research strategies for prevention of SNH are presented. Impact: Transcutaneous screening for neonatal hyperbilirubinemia contributes to the prevention of SNH. A smartphone application with optical bilirubin estimation seems a promising low-cost screening method, especially in low-resource settings or at home.Afdeling Klinische Chemie en Laboratoriumgeneeskunde (AKCL

Diagnostic methods for neonatal hyperbilirubinemia:benefits, limitations, requirements, and novel developments

Invasive bilirubin measurements remain the gold standard for the diagnosis and treatment of infants with severe neonatal hyperbilirubinemia. The present paper describes different methods currently available to assess hyperbilirubinemia in newborn infants. Novel point-of-care bilirubin measurement methods, such as the BiliSpec and the Bilistick, would benefit many newborn infants, especially in low-income and middle-income countries where the access to costly multi-analyzer in vitro diagnostic instruments is limited. Total serum bilirubin test results should be accurate within permissible limits of measurement uncertainty to be fit for clinical purposes. This implies correct implementation of internationally endorsed reference measurement systems as well as participation in external quality assessment programs. Novel analytic methods may, apart from bilirubin, include the determination of bilirubin photoisomers and bilirubin oxidation products in blood and even in other biological matrices. ImpactKey message: Bilirubin measurements in blood remain the gold standard for diagnosis and treatment of severe neonatal hyperbilirubinemia (SNH). External quality assessment (EQA) plays an important role in revealing inaccuracies in diagnostic bilirubin measurements. What does this article add to the existing literature? We provide analytic performance data on total serum bilirubin (TSB) as measured during recent EQA surveys. We review novel diagnostic point-of-care (POC) bilirubin measurement methods and analytic methods for determining bilirubin levels in biological matrices other than blood. Impact: Manufacturers should make TSB test results traceable to the internationally endorsed total bilirubin reference measurement system and should ensure permissible limits of measurement uncertainty.Afdeling Klinische Chemie en Laboratoriumgeneeskunde (AKCL

Functional Induction of the Cystine-Glutamate Exchanger System Xc- Activity in SH-SY5Y Cells by Unconjugated Bilirubin

We have previously reported that exposure of SH-SY5Y neuroblastoma cells to unconjugated bilirubin (UCB) resulted in a marked up-regulation of the mRNA encoding for the Na+ -independent cystine∶glutamate exchanger System Xc− (SLC7A11 and SLC3A2 genes). In this study we demonstrate that SH-SY5Y cells treated with UCB showed a higher cystine uptake due to a significant and specific increase in the activity of System Xc−, without the contribution of the others two cystine transporters (XAG− and GGT) reported in neurons. The total intracellular glutathione content was 2 folds higher in the cells exposed to bilirubin as compared to controls, suggesting that the internalized cystine is used for gluthathione synthesis. Interestingly, these cells were significantly less sensitive to an oxidative insult induced by hydrogen peroxide. If System Xc− is silenced the protection is lost. In conclusion, these results suggest that bilirubin can modulate the gluthathione levels in neuroblastoma cells through the induction of the System Xc−, and this renders the cell less prone to oxidative damage

Città come grandi attrattori di turismo culturale: accoglienza e gestione dei visitatori nel centro storico di Firenze

L’Association for Tourism and Leisure Education (ATLAS, 2005), definisce il turismo culturale come «il movimento delle persone verso attrattori culturali lontano dal loro luogo di residenza, con l’obiettivo di vivere nuove esperienze per soddisfare i loro bisogni culturali». Per quanto riguarda questo ultimo aspetto la visita a città d’arte, a musei e a mostre si pone nel 2012 al secondo posto rispetto al complesso dei consumi culturali (Grossi, 2013). In questo contesto, quale legame esiste tra le città d’arte considerate grandi attrattori e il fenomeno turistico che in esse si sviluppa? Con 11 milioni di turisti nel 2012 (Provincia di Firenze, 2012), Firenze conta di un’ottantina di realtà museali in un contesto architettonico visitato ogni anno da turisti provenienti da tutto il mondo. Con una vacanza che dura in media da 1 a 7 notti, i turisti sono principalmente interessati alla visita degli attrattori più noti (Uffizi, Palazzo vecchio e Palazzo vecchio) rispetto ad aree centrali ma meno conosciute. Proprio questo tema è oggetto di studio del progetto che SiTI – Istituto Superiore sui Sistemi Territoriali per l’Innovazione ha sviluppato insieme all’Ufficio UNESCO del Comune di Firenze. “Destinazione Firenze: accoglienza e gestione dei visitatori nel centro Storico di Firenze” ha infatti come obiettivo quello di delocalizzare i flussi turistici al fine di sensibilizzare turisti e cittadini verso le aree della città poco conosciute. In stretta collaborazione, applicando la metodologia del visitor management (Levi Sacerdotti et al., 2011), SiTI e l’Ufficio UNESCO del Comune di Firenze stanno sviluppando otto differenti analisi relative alla domanda e all’offerta turistica, non solo da un punto di vista della ricerca, ma anche e soprattutto coinvolgendo step by step gli attori del territorio e i portatori di interesse. Gli studi riguardano nello specifico l’analisi della domanda turistica, un approfondimento “pilota” sull’utilizzo della Firenze Card, un’indagine di Mystery Client, un’analisi di posizionamento della città di Firenze nel panorama nazionale ed internazionale, un’analisi dei luoghi poco fruiti attraverso la lettura delle guide turistiche, un progetto pilota di omogeneizzazione dei dati culturali cartografici provenienti dai diversi soggetti del territorio, un’analisi percettiva attraverso la realizzazione di un video e l’elaborazione dei dati emersi dal percorso di partecipazione avvenuto con gli attori del territorio sulle tematiche di ospitalità, mobilità e cultura. Il contributo illustra le diverse metodologie che, strutturate e applicate al contesto della città di Firenze in modo trasversale ed integrato, condurranno allo sviluppo delle linee guida di tourism management relative al Piano di Gestione del Centro Storico UNESCO. Le idee operative sono state strutturate attraverso schede azione relative a otto ambiti di sviluppo ritenuti precipui e intrecciati tra loro